Shock: acute circulatory failure, with inadequate tissue perfusion causing cellular hypoxia
Inadequate tissue perfusion can be due to reduced preload, pump failure, or reduced afterload.
Whilst hypotension is often present with shock and contributes to inadequate tissue perfusion, there can be shock with normal blood pressure.
4 principal categories of shock:
There may be multiple factors contributing to shocked state – for example a septic patient where the principal problem is vasodilation, but who is also hypovolaemic from ileus and drain losses.
Management of shock:
Prompt assessment and immediate management following principles of the CCrISP algorithm
Signs of decreased tissue perfusion / shock:
- Cool peripheries
- Shut down peripheral veins
- Increased resp rate
- Prolonged CRT > 2 s
- Poor pulse oximeter signal
- Poor urine output
- Anxiety and restlessness
- Altered level of consciousness
- Metabolic acidosis or raised lactate
The management of shock is directed at the underlying cause but in general improving cardiac output and optimising oxygenisation is key
- Primary survey / immediate management as per ABCDE
- High flow oxygen
- Large bore IV access
- IV fluid bolus (unless high suspicious cardiogenic/obstructive shock) – 10 – 20 mL / kg
- Appropriate monitoring
- Call for help – ?does the patient need a higher level of care
- Early antibiotics if sepsis considered
- Catheterisation for urine output monitoring
- Assess response to fluids
- Diagnosis and treatment of underlying cause